Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $33.11 / $117.49 / $575.44	Facility		$33.11	$117.49	$575.44
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.55 / $10.96 / $24.55	Facility	26	$9.55	$10.96	$24.55
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $23.44 / $45.71 / $426.58	Facility	TC	$23.44	$45.71	$426.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $22.91 / $37.15 / $112.20	Professional		$22.91	$37.15	$112.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.59 / $11.48 / $40.74	Professional	26	$7.59	$11.48	$40.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.14 / $22.91 / $70.79	Professional	TC	$15.14	$22.91	$70.79
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $20.42 / $33.88 / $64.57	Professional		$20.42	$33.88	$64.57
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.31 / $14.45 / $16.98	Professional	26	$6.31	$14.45	$16.98
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $33.88 / $47.86	Professional	TC	$18.20	$33.88	$47.86
Cigna Facility/Professional Facility Modifier Low / Median / High Price $234.42 / $389.05 / $501.19	Facility		$234.42	$389.05	$501.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $24.55 / $44.67 / $83.18	Professional		$24.55	$44.67	$83.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.59 / $13.49 / $24.55	Professional	26	$7.59	$13.49	$24.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.60 / $30.90 / $60.26	Professional	TC	$16.60	$30.90	$60.26
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $30.90 / $60.26 / $165.96	Facility		$30.90	$60.26	$165.96
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $9.33 / $16.60 / $165.96	Facility	26	$9.33	$16.60	$165.96
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $20.42 / $40.74 / $165.96	Facility	TC	$20.42	$40.74	$165.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $52.48 / $75.86	Professional		$28.18	$52.48	$75.86
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.13 / $15.49 / $21.38	Professional	26	$8.13	$15.49	$21.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $38.90 / $54.95	Professional	TC	$20.42	$38.90	$54.95
Molina Facility/Professional Professional Modifier Low / Median / High Price $13.18 / $32.36 / $33.11	Professional		$13.18	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $43.65 / $54.95 / $60.26	Facility		$43.65	$54.95	$60.26
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $13.80 / $16.60 / $16.98	Facility	26	$13.80	$16.60	$16.98
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $30.90 / $37.15 / $39.81	Facility	TC	$30.90	$37.15	$39.81
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $15.14 / $18.62	Professional	26	$10.00	$15.14	$18.62
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $31.62 / $43.65	Professional	TC	$21.88	$31.62	$43.65
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $38.02 / $38.02 / $38.02	Facility		$38.02	$38.02	$38.02
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $11.22 / $11.22 / $11.48	Facility	26	$11.22	$11.22	$11.48
Premera BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $26.30 / $26.30 / $26.92	Facility	TC	$26.30	$26.30	$26.92
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $61.66 / $81.28	Professional		$38.02	$61.66	$81.28
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $18.20 / $25.12	Professional	26	$11.48	$18.20	$25.12
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $43.65 / $58.88	Professional	TC	$26.92	$43.65	$58.88
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $213.80 / $302.00 / $602.56	Facility		$213.80	$302.00	$602.56
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $213.80 / $213.80 / $213.80	Facility	26	$213.80	$213.80	$213.80
Regence BlueShield Facility/Professional Facility Modifier TC Low / Median / High Price $213.80 / $213.80 / $213.80	Facility	TC	$213.80	$213.80	$213.80
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $58.88 / $77.62	Professional		$39.81	$58.88	$77.62
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $17.78 / $23.44	Professional	26	$11.75	$17.78	$23.44
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $40.74 / $54.95	Professional	TC	$26.92	$40.74	$54.95
United Facility/Professional Facility Modifier Low / Median / High Price $295.12 / $398.11 / $707.95	Facility		$295.12	$398.11	$707.95
United Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $31.62 / $72.44	Professional		$25.70	$31.62	$72.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.59 / $9.55 / $21.88	Professional	26	$7.59	$9.55	$21.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $21.88 / $51.29	Professional	TC	$16.98	$21.88	$51.29
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $33.11 / $54.95	Professional		$28.84	$33.11	$54.95
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $9.77 / $16.22	Professional	26	$8.51	$9.77	$16.22
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $23.99 / $38.90	Professional	TC	$20.42	$23.99	$38.90